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Subject: search.filters.subject.cardiopulmonary bypass

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    Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery BypassGrafting With Cardiopulmonary Bypass
    (FRONTIERS MEDIA SA, 2022-01-01) Aykut, Gueclue; Ulugoel, Halim; Aksu, Ugur; Akin, Sakir; Karabulut, Hasan; Alhan, Cem; Toraman, Fevzi; Ince, Can
    Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T-0) to discontinuation of CPB (T-5).Results: In the both crystalloid {[}crystalloid cardioplegia group (CCG)] and blood cardioplegia {[}blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T-0 to T-5 (\%Delta)(T0-T5) in all the functional microcirculatory parameters {[}\%Delta TVDT0-T5(CCG): -10.86 +/- 2.323 vs. \%Delta TVDT0-T5(BCG): 0.0804 +/- 1.107, p < 0.001
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    Percutaneous cannulation for cardiopulmonary bypass in robotic mitral valve surgery with zero groin complications
    (WILEY, 2022-01-01) Bastopcu, Murat; Senay, Sahin; Gullu, Ahmet U.; Kocyigit, Muharrem; Alhan, Cem
    Introduction Robotic valve surgery utilizes the femoral vessels to set up cardiopulmonary bypass (CPB) which translates to groin wound and lower extremity vascular complications. A less invasive technique is a totally percutaneous bypass using vascular closure devices (VCDs) with concerns for lower limb ischemia and arterial stenosis. Since April 2018, we have adopted the standard use of total percutaneous CPB in our robotic mitral cases. We report our institutional results with this technique. Methods All consecutive patients who underwent robotic mitral valve surgery between April 2018 and December 2020 in our institution were included in our study. Hospital database data on demographics, operative variables, and surgical outcomes were recorded and analyzed. Results Robotic mitral valve surgeries were performed on 32 consecutive patients (mean age 57.2 +/- 14.8) between April 2018 and December 2020. None of our patients developed an infection at any site. Seroma, hematoma, or pseudoaneurysm were not observed at puncture sites. Surgical repair of the femoral vessels or an additional VCD was not necessary for any of our patients. Patients were followed up for a mean duration of 23.5 months. Our patients did not present with a late wound infection, a seroma, or a pseudoaneurysm, nor had complaints of limb ischemia or claudication. Conclusion Total percutaneous bypass is the least invasive method of establishing extracorporeal circulation for cardiac surgery and can be performed with excellent results. The benefits of robotic surgery can be expanded with better results in groin cannulation by the adoption of total percutaneous CPB.
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    Utility of Cervical Cannulation During Difficult Resternotomy in Congenital Heart Surgery
    (SAGE PUBLICATIONS INC, 2020-01-01) Temur, Bahar; Davutoglu, Arda; Dogruoz, Alper; Aydin, Selim; Suzan, Dilek; Kirat, Baris; Odemis, Ender; Erek, Ersin
    Background: Adhesions due to previous surgeries and some anatomical difficulties may make resternotomy dangerous in children. Femoral vessels are usually small and may not be suitable for cannulation. The aim of this report is to describe our experience with cervical cannulation during risky resternotomy in children. Methods: Between January 2014 and January 2018, cervical cannulation was performed in eight pediatric patients during sternal reentry. Their ages were between 3 months and 17 years (mean: 5.4 years). Three patients underwent stage III extracardiac Fontan operation with the diagnosis of hypoplastic left heart syndrome. Three patients had supravalvular aortic and/or pulmonary stenosis after previous arterial switch operation. One patient had proximal aortic arch stenosis and subvalvular aortic stenosis after interrupted aortic arch repair. The last patient had aortic root pseudoaneurysm and aortic insufficiency due to endocarditis. Through a separate cervical incision, a polytetrafluoroethylene graft was anastomosed to the common carotid artery and the arterial cannula was inserted into the graft. Antegrade selective cerebral perfusion (ASCP) was used in two patients. Results: During resternotomies, no major injury or bleeding occurred. Three-month-old patient who had previous interrupted aortic arch repair died despite extracorporeal membrane oxygenation support due to sepsis and multi-organ failure. Median intensive care unit stay and hospital stay were 3 days (1-40 days) and 17 days (7-60 days), respectively. Mean follow-up was 17.9 +/- 15.8 months. All patients were in good clinical condition. Conclusions: Cervical cannulation may be a useful and safe technique during high-risk resternotomy in children. This technique may also simplify the performance of ASCP if necessary.